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CMS Considers Use of Clinical Registry Data to Assess Quality

HealthLeaders Media reported in April that the Centers for Medicare and Medicaid Services (CMS) is investigating whether it should use outcomes data now reported by physicians and hospitals to specialty societies as part of its efforts to assess and reward providers based on the quality of their care. Voluntary reporting registries, which are becoming increasingly common, track outcomes for surgery and other invasive procedures and report results to providers. For example, the American College of Surgeons National Surgical Quality Improvement Program collects data from 700 hospitals on surgical outcomes—and uses the information to inform its efforts to help hospitals improve the quality of care. CMS received 100 responses from medical specialty societies and provider groups to its request for information about the proposal.

More Care Is More Lucrative Than Better Care

There was widespread media coverage, including in the Wall Street Journal and the New York Times, of the April 17 Journal of the American Medical Association study reporting that infections and other complications of hospital treatment can add substantially to hospitals' earnings. While this is likely not news to those in health care, the study, based on detailed analyses of 34,256 patient records from 12 Texas hospitals, is according to the authors the first to quantify how perverse financial incentives affect hospitals' bottom line. For the 1,820 patients who experienced complications, hospital revenue averaged $30,500 more than for patients without complications. Payments were much higher for privately insured patients than for those with Medicare. 

Challenges to Incorporating Nurse Practitioners into Health Care Teams

A HealthLeaders Media analysis on "The Trouble with Nurse Practitioners" outlined the challenges of incorporating nurse practitioners and other mid-level providers into health care teams—something many hospitals and health systems are doing as they prepare to meet demand from millions of newly insured patients. According to the analysis, the challenges include an inadequate supply of nurse practitioners, physician pushback, and restrictive state licensing standards. Several studies have shown that nurse practitioners can help health care organizations improve health care quality and safety, patient flow, productivity, and patient experiences.  

Health Insurers Spent Less Than 1% of Premium Dollars on Care Improvement in 2011

Health insurance companies reported spending an average of less than 1 percent of the premiums they collected from policyholders in 2011 on activities directly supporting improvement of health care quality, according to a recent Commonwealth Fund study. The new report looks at differences in medical loss ratios, consumer rebates, and quality improvement expenses, based on insurers' corporate structure and ownership. The authors find that insurance companies spent a combined $2.3 billion on direct quality improvement activities, an average of $29 per subscriber. The Affordable Care Act's medical loss ratio rule requires insurers to spend at least 80 or 85 percent of premiums on medical claims and quality improvement activities―those likely to improve health outcomes, prevent hospital readmissions, improve patient safety, and increase wellness and health promotion―or else pay rebates to consumers. 

AHRQ's "Closing the Quality Gap" Evidence Report Summaries 
The Agency for Healthcare Research and Quality (AHRQ) has developed free summaries of the evidence in support of eight different quality improvement strategies: bundled payments; patient-centered medical homes; addressing health disparities; medication adherence; public reporting; prevention of health care–associated infections; measuring outcomes for the disabled; and improving health care and palliative care for advanced illness. The report series, known as Closing the Quality Gap: Revisiting the State of the Science, can be viewed at the AHRQ website or ordered via [email protected].

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